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Re: Vitamin D Supplement

But we are physiologically built to synthesize vitamin D in the skin through the exposure of cholesterols to a specific range of UVB (including infants). This system is very finely tuned. Vitamin D acquisition from any food sources has been shown to be far less efficient than through photosynthesis. Because we are not build to get vitamin D primarily from dietary sources, I see no reason to believe that explanation a priori in this specific case.

In fact, the most recent paper available (Wagner et al., 2006) assessing infant supplementation (300 IU/d) versus maternal supplementation (6400 IU/d) shows that levels were not significantly different between the infant group on oral supplements and the infant group receiving vitamin D through breast milk alone. Furthermore, levels were still insufficient in each group after supplementation. This leads me to believe that vitamin D is uniquely not more bioavailable from breast milk compared to a supplement.

However, that paper is based on a pilot study (19 participants) and is by no means conclusive. If anyone can direct me to some published data showing otherwise I'm more than happy to recant my statements here, but based on what I've seen to date I'm pretty convinced that you can't compare vitamin D to other nutrients.

My impression is that breast milk is all an infant is meant to eat, but an infant is meant to get out in the sun too.

Re: Vitamin D Supplement

But the PP said If the mother had sufficient levels that is would be transferred through breast milk. To me that meant through the skin. I didn't assume she meant that sufficient levels through sun. That is what I think when I think "sufficient levels". That people get them through the sun. That if you don't have adequate exposure than you'd know that. And you'd be someone who would supplement. I have known women here that DID NOT feel like they personally had adequate exposure to the sun because of where they lived (Alaska for example) and supplemented for that reason.
I live in CA. I didn't not worry about my Son's vitamin D levels AT ALL the 1st year of his life. Because of my exposure and the fact that he was EBF. Later in life I have been known to supplement (though not with consistency) because of the fact that he is dark skinned.
I also agree that babies are supposed to get some sun. But the fact that it is stored in our system means that that exposure doesn't have to be continual.

Re: Vitamin D Supplement

Originally Posted by @llli*djs.mom

But the PP said If the mother had sufficient levels that is would be transferred through breast milk. To me that meant through the skin.

But it doesn't matter how a mother gets her vitamin D, through sunlight exposure on the skin or through a supplement. While a small amount of vitamin D is transferred through through breast milk when a mother has adequate levels, it is not even close to sufficient for an infant. Even when the mother takes a very high dose supplement (6400 IU/d, far above recommended, and proven safe in the long term, doses at 1,000-2,000 IU/d) the levels present in her milk do not provide adequate vitamin D to her infant.

My point is that infants are built to get vitamin D through sunlight exposure on their skin, not through breast milk.

Through the bulk of human history, mothers would have young infants outside in the sun. Thus, there was never a need for vitamin D to pass through breast milk very well - so it doesn't. Nor was there ever any need for it to be absorbed more easily by the infant, as the forms of vitamin D presenting breast milk are the same as the forms in supplements, which are different and less efficacious as the form produced by photosynthesis. But our lifestyles have changed and we hide from the sun now, so our infants no longer have the natural source of vitamin D and we wind up with deficiency.

The only solutions are: 1, Get the infant out in the sun, dressed appropriately and for adequate periods of time. 2, Supplement the infant. 3, And (possibly) supplement the mother with extremely high doses of vitamin D3 (this one is risky though as it has not been proven safe or effective at this point).

The PP stated:

Originally Posted by @llli*raejoy

There is Vit D in your BM that is more easily absorbed by baby than any supplement...

And while this is true for other vitamins, minerals, and other compounds which our physiology is "designed" to obtain from dietary sources, vitamin D is much different from these other materials as our physiology is not "designed" to obtain it from dietary sources. Furthermore, as far as I know there is no evidence that shows this to be true. Even if it is true, vitamin D in breast milk does not occur in sufficient quantities to support an infant. The infant needs sunlight exposure. Which she states:

Originally Posted by @llli*raejoy

...and the rest can be gotten from 5-10 minutes' exposure of the arms and legs 2-3 times a week.

And I agree with this second part (although I believe the recommendation is also exposure on the face, neck, abdomen or back) for certain individuals living in certain climates. Latitude effects the amount of incoming solar radiation, so just because it is nice and sunny it does not mean that you are able to get adequate vitamin D from sunlight alone depending on your skin tone in such a short time.

Anyway, I think the danger here is to assume that our infants are "designed" to get vitamin D from our milk. Or that our milk is "designed" to provide vitamin D to our infants. Neither of these things are true. Infants are "designed" to get vitamin D from the sun just like everyone else. As such, as long as an infant gets enough sun exposure w.r.t skin tone, then that infant will get adequate vitamin D. If not then a supplement is needed.

Because of the deficiency and insufficiency rates in the US and around the world, it is clear that many infants are not getting enough sunlight exposure which is why supplements are recommended. Doctors are rarely going to recommend sunlight exposure because it is difficult to quantify how much is needed and for liability reasons (i.e. melanoma).